intensive outpatient/partial hospitalization liability tables...allegheny intensive...

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Adams Intensive Outpatient/Partial Hospitalization Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Equal to or Equal to or Equal to or Equal to or Equal to or Equal to or Income Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than 1 $1,740 $2,262 $2,784 $3,306 $3,828 $4,350 $4,350 2 $2,359 $3,067 $3,775 $4,483 $5,190 $5,898 $5,898 3 $2,978 $3,872 $4,766 $5,659 $6,553 $7,446 $7,446 4 $3,598 $4,677 $5,756 $6,836 $7,915 $8,994 $8,994 5 $4,217 $5,482 $6,747 $8,012 $9,277 $10,542 $10,542 6 $4,836 $6,287 $7,738 $9,189 $10,639 $12,090 $12,090 7 $5,455 $7,092 $8,728 $10,365 $12,002 $13,638 $13,638 8 $6,074 $7,897 $9,719 $11,541 $13,364 $15,186 $15,186 9 $6,694 $8,702 $10,710 $12,718 $14,726 $16,734 $16,734 10 $7,313 $9,507 $11,701 $13,894 $16,088 $18,282 $18,282 Client Liability: 0% 10% 20% 30% 40% 50% 100%

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Page 1: Intensive Outpatient/Partial Hospitalization Liability Tables...Allegheny Intensive Outpatient/Partial Hospitalization Monthly Income Monthly Income Monthly Income Monthly Income Monthly

Ada

ms

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,740 $2,262 $2,784 $3,306 $3,828 $4,350 $4,3502 $2,359 $3,067 $3,775 $4,483 $5,190 $5,898 $5,8983 $2,978 $3,872 $4,766 $5,659 $6,553 $7,446 $7,4464 $3,598 $4,677 $5,756 $6,836 $7,915 $8,994 $8,9945 $4,217 $5,482 $6,747 $8,012 $9,277 $10,542 $10,5426 $4,836 $6,287 $7,738 $9,189 $10,639 $12,090 $12,0907 $5,455 $7,092 $8,728 $10,365 $12,002 $13,638 $13,6388 $6,074 $7,897 $9,719 $11,541 $13,364 $15,186 $15,1869 $6,694 $8,702 $10,710 $12,718 $14,726 $16,734 $16,734

10 $7,313 $9,507 $11,701 $13,894 $16,088 $18,282 $18,282

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Page 2: Intensive Outpatient/Partial Hospitalization Liability Tables...Allegheny Intensive Outpatient/Partial Hospitalization Monthly Income Monthly Income Monthly Income Monthly Income Monthly

Alle

ghen

y

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,811 $2,354 $2,897 $3,441 $3,984 $4,527 $4,5272 $2,455 $3,192 $3,928 $4,665 $5,402 $6,138 $6,1383 $3,100 $4,030 $4,959 $5,889 $6,819 $7,749 $7,7494 $3,744 $4,867 $5,991 $7,114 $8,237 $9,360 $9,3605 $4,388 $5,705 $7,022 $8,338 $9,655 $10,971 $10,9716 $5,033 $6,543 $8,053 $9,562 $11,072 $12,582 $12,5827 $5,677 $7,380 $9,084 $10,787 $12,490 $14,193 $14,1938 $6,322 $8,218 $10,115 $12,011 $13,908 $15,804 $15,8049 $6,966 $9,056 $11,146 $13,236 $15,325 $17,415 $17,415

10 $7,610 $9,894 $12,177 $14,460 $16,743 $19,026 $19,026

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Page 3: Intensive Outpatient/Partial Hospitalization Liability Tables...Allegheny Intensive Outpatient/Partial Hospitalization Monthly Income Monthly Income Monthly Income Monthly Income Monthly

Arm

stro

ng

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,639 $2,131 $2,622 $3,114 $3,606 $4,097 $4,0972 $2,222 $2,889 $3,555 $4,222 $4,889 $5,555 $5,5553 $2,805 $3,647 $4,488 $5,330 $6,172 $7,013 $7,0134 $3,389 $4,405 $5,422 $6,438 $7,455 $8,471 $8,4715 $3,972 $5,163 $6,355 $7,546 $8,738 $9,929 $9,9296 $4,555 $5,921 $7,288 $8,654 $10,021 $11,387 $11,3877 $5,138 $6,680 $8,221 $9,762 $11,304 $12,845 $12,8458 $5,721 $7,438 $9,154 $10,870 $12,587 $14,303 $14,3039 $6,305 $8,196 $10,087 $11,979 $13,870 $15,761 $15,761

10 $6,888 $8,954 $11,020 $13,087 $15,153 $17,219 $17,219

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Page 4: Intensive Outpatient/Partial Hospitalization Liability Tables...Allegheny Intensive Outpatient/Partial Hospitalization Monthly Income Monthly Income Monthly Income Monthly Income Monthly

Bea

ver

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,700 $2,209 $2,719 $3,229 $3,739 $4,249 $4,2492 $2,304 $2,996 $3,687 $4,378 $5,070 $5,761 $5,7613 $2,909 $3,782 $4,655 $5,527 $6,400 $7,273 $7,2734 $3,514 $4,568 $5,622 $6,677 $7,731 $8,785 $8,7855 $4,119 $5,354 $6,590 $7,826 $9,061 $10,297 $10,2976 $4,724 $6,141 $7,558 $8,975 $10,392 $11,809 $11,8097 $5,328 $6,927 $8,525 $10,124 $11,722 $13,321 $13,3218 $5,933 $7,713 $9,493 $11,273 $13,053 $14,833 $14,8339 $6,538 $8,499 $10,461 $12,422 $14,384 $16,345 $16,345

10 $7,143 $9,286 $11,428 $13,571 $15,714 $17,857 $17,857

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Page 5: Intensive Outpatient/Partial Hospitalization Liability Tables...Allegheny Intensive Outpatient/Partial Hospitalization Monthly Income Monthly Income Monthly Income Monthly Income Monthly

Bed

ford

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,609 $2,091 $2,574 $3,056 $3,539 $4,021 $4,0212 $2,181 $2,835 $3,490 $4,144 $4,798 $5,452 $5,4523 $2,753 $3,579 $4,405 $5,231 $6,057 $6,883 $6,8834 $3,326 $4,323 $5,321 $6,319 $7,317 $8,314 $8,3145 $3,898 $5,068 $6,237 $7,406 $8,576 $9,745 $9,7456 $4,471 $5,812 $7,153 $8,494 $9,835 $11,176 $11,1767 $5,043 $6,556 $8,069 $9,582 $11,094 $12,607 $12,6078 $5,615 $7,300 $8,985 $10,669 $12,354 $14,038 $14,0389 $6,188 $8,044 $9,900 $11,757 $13,613 $15,469 $15,469

10 $6,760 $8,788 $10,816 $12,844 $14,872 $16,900 $16,900

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Page 6: Intensive Outpatient/Partial Hospitalization Liability Tables...Allegheny Intensive Outpatient/Partial Hospitalization Monthly Income Monthly Income Monthly Income Monthly Income Monthly

Ber

ks

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,831 $2,380 $2,930 $3,479 $4,028 $4,578 $4,5782 $2,483 $3,228 $3,972 $4,717 $5,462 $6,207 $6,2073 $3,134 $4,075 $5,015 $5,955 $6,895 $7,836 $7,8364 $3,786 $4,922 $6,057 $7,193 $8,329 $9,465 $9,4655 $4,438 $5,769 $7,100 $8,431 $9,763 $11,094 $11,0946 $5,089 $6,616 $8,143 $9,669 $11,196 $12,723 $12,7237 $5,741 $7,463 $9,185 $10,907 $12,630 $14,352 $14,3528 $6,392 $8,310 $10,228 $12,145 $14,063 $15,981 $15,9819 $7,044 $9,157 $11,270 $13,383 $15,497 $17,610 $17,610

10 $7,696 $10,004 $12,313 $14,621 $16,930 $19,239 $19,239

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Page 7: Intensive Outpatient/Partial Hospitalization Liability Tables...Allegheny Intensive Outpatient/Partial Hospitalization Monthly Income Monthly Income Monthly Income Monthly Income Monthly

Bla

ir

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,619 $2,104 $2,590 $3,075 $3,561 $4,047 $4,0472 $2,195 $2,853 $3,511 $4,170 $4,828 $5,487 $5,4873 $2,771 $3,602 $4,433 $5,264 $6,095 $6,927 $6,9274 $3,347 $4,351 $5,355 $6,359 $7,363 $8,367 $8,3675 $3,923 $5,099 $6,276 $7,453 $8,630 $9,807 $9,8076 $4,499 $5,848 $7,198 $8,547 $9,897 $11,247 $11,2477 $5,075 $6,597 $8,119 $9,642 $11,164 $12,687 $12,6878 $5,651 $7,346 $9,041 $10,736 $12,431 $14,127 $14,1279 $6,227 $8,095 $9,963 $11,831 $13,699 $15,567 $15,567

10 $6,803 $8,843 $10,884 $12,925 $14,966 $17,007 $17,007

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Page 8: Intensive Outpatient/Partial Hospitalization Liability Tables...Allegheny Intensive Outpatient/Partial Hospitalization Monthly Income Monthly Income Monthly Income Monthly Income Monthly

Bra

dfor

d

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,609 $2,091 $2,574 $3,056 $3,539 $4,021 $4,0212 $2,181 $2,835 $3,490 $4,144 $4,798 $5,452 $5,4523 $2,753 $3,579 $4,405 $5,231 $6,057 $6,883 $6,8834 $3,326 $4,323 $5,321 $6,319 $7,317 $8,314 $8,3145 $3,898 $5,068 $6,237 $7,406 $8,576 $9,745 $9,7456 $4,471 $5,812 $7,153 $8,494 $9,835 $11,176 $11,1767 $5,043 $6,556 $8,069 $9,582 $11,094 $12,607 $12,6078 $5,615 $7,300 $8,985 $10,669 $12,354 $14,038 $14,0389 $6,188 $8,044 $9,900 $11,757 $13,613 $15,469 $15,469

10 $6,760 $8,788 $10,816 $12,844 $14,872 $16,900 $16,900

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Page 9: Intensive Outpatient/Partial Hospitalization Liability Tables...Allegheny Intensive Outpatient/Partial Hospitalization Monthly Income Monthly Income Monthly Income Monthly Income Monthly

Buc

ks

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $2,600 $3,380 $4,160 $4,940 $5,720 $6,500 $6,5002 $3,525 $4,583 $5,640 $6,698 $7,755 $8,813 $8,8133 $4,450 $5,785 $7,121 $8,456 $9,791 $11,126 $11,1264 $5,376 $6,988 $8,601 $10,214 $11,826 $13,439 $13,4395 $6,301 $8,191 $10,081 $11,971 $13,862 $15,752 $15,7526 $7,226 $9,394 $11,562 $13,729 $15,897 $18,065 $18,0657 $8,151 $10,597 $13,042 $15,487 $17,933 $20,378 $20,3788 $9,076 $11,799 $14,522 $17,245 $19,968 $22,691 $22,6919 $10,002 $13,002 $16,003 $19,003 $22,003 $25,004 $25,004

10 $10,927 $14,205 $17,483 $20,761 $24,039 $27,317 $27,317

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Page 10: Intensive Outpatient/Partial Hospitalization Liability Tables...Allegheny Intensive Outpatient/Partial Hospitalization Monthly Income Monthly Income Monthly Income Monthly Income Monthly

But

ler

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,841 $2,394 $2,946 $3,498 $4,051 $4,603 $4,6032 $2,496 $3,245 $3,994 $4,743 $5,492 $6,241 $6,2413 $3,152 $4,097 $5,043 $5,988 $6,934 $7,879 $7,8794 $3,807 $4,949 $6,091 $7,233 $8,375 $9,517 $9,5175 $4,462 $5,801 $7,139 $8,478 $9,816 $11,155 $11,1556 $5,117 $6,652 $8,188 $9,723 $11,258 $12,793 $12,7937 $5,772 $7,504 $9,236 $10,968 $12,699 $14,431 $14,4318 $6,428 $8,356 $10,284 $12,213 $14,141 $16,069 $16,0699 $7,083 $9,208 $11,333 $13,457 $15,582 $17,707 $17,707

10 $7,738 $10,059 $12,381 $14,702 $17,024 $19,345 $19,345

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Page 11: Intensive Outpatient/Partial Hospitalization Liability Tables...Allegheny Intensive Outpatient/Partial Hospitalization Monthly Income Monthly Income Monthly Income Monthly Income Monthly

Cam

bria

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,558 $2,025 $2,493 $2,960 $3,428 $3,895 $3,8952 $2,112 $2,746 $3,380 $4,013 $4,647 $5,281 $5,2813 $2,667 $3,467 $4,267 $5,067 $5,867 $6,667 $6,6674 $3,221 $4,188 $5,154 $6,120 $7,087 $8,053 $8,0535 $3,776 $4,908 $6,041 $7,174 $8,306 $9,439 $9,4396 $4,330 $5,629 $6,928 $8,227 $9,526 $10,825 $10,8257 $4,884 $6,350 $7,815 $9,280 $10,746 $12,211 $12,2118 $5,439 $7,070 $8,702 $10,334 $11,965 $13,597 $13,5979 $5,993 $7,791 $9,589 $11,387 $13,185 $14,983 $14,983

10 $6,548 $8,512 $10,476 $12,440 $14,405 $16,369 $16,369

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Page 12: Intensive Outpatient/Partial Hospitalization Liability Tables...Allegheny Intensive Outpatient/Partial Hospitalization Monthly Income Monthly Income Monthly Income Monthly Income Monthly

Cam

eron

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,598 $2,078 $2,557 $3,037 $3,517 $3,996 $3,9962 $2,167 $2,817 $3,468 $4,118 $4,768 $5,418 $5,4183 $2,736 $3,557 $4,378 $5,198 $6,019 $6,840 $6,8404 $3,305 $4,296 $5,288 $6,279 $7,271 $8,262 $8,2625 $3,874 $5,036 $6,198 $7,360 $8,522 $9,684 $9,6846 $4,442 $5,775 $7,108 $8,441 $9,773 $11,106 $11,1067 $5,011 $6,515 $8,018 $9,521 $11,025 $12,528 $12,5288 $5,580 $7,254 $8,928 $10,602 $12,276 $13,950 $13,9509 $6,149 $7,993 $9,838 $11,683 $13,527 $15,372 $15,372

10 $6,718 $8,733 $10,748 $12,764 $14,779 $16,794 $16,794

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Page 13: Intensive Outpatient/Partial Hospitalization Liability Tables...Allegheny Intensive Outpatient/Partial Hospitalization Monthly Income Monthly Income Monthly Income Monthly Income Monthly

Car

bon

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,700 $2,209 $2,719 $3,229 $3,739 $4,249 $4,2492 $2,304 $2,996 $3,687 $4,378 $5,070 $5,761 $5,7613 $2,909 $3,782 $4,655 $5,527 $6,400 $7,273 $7,2734 $3,514 $4,568 $5,622 $6,677 $7,731 $8,785 $8,7855 $4,119 $5,354 $6,590 $7,826 $9,061 $10,297 $10,2976 $4,724 $6,141 $7,558 $8,975 $10,392 $11,809 $11,8097 $5,328 $6,927 $8,525 $10,124 $11,722 $13,321 $13,3218 $5,933 $7,713 $9,493 $11,273 $13,053 $14,833 $14,8339 $6,538 $8,499 $10,461 $12,422 $14,384 $16,345 $16,345

10 $7,143 $9,286 $11,428 $13,571 $15,714 $17,857 $17,857

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Page 14: Intensive Outpatient/Partial Hospitalization Liability Tables...Allegheny Intensive Outpatient/Partial Hospitalization Monthly Income Monthly Income Monthly Income Monthly Income Monthly

Cen

tre

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,953 $2,538 $3,124 $3,710 $4,296 $4,881 $4,8812 $2,647 $3,442 $4,236 $5,030 $5,824 $6,618 $6,6183 $3,342 $4,345 $5,347 $6,350 $7,353 $8,355 $8,3554 $4,037 $5,248 $6,459 $7,670 $8,881 $10,092 $10,0925 $4,732 $6,151 $7,571 $8,990 $10,410 $11,829 $11,8296 $5,427 $7,054 $8,682 $10,310 $11,938 $13,566 $13,5667 $6,121 $7,958 $9,794 $11,631 $13,467 $15,303 $15,3038 $6,816 $8,861 $10,906 $12,951 $14,995 $17,040 $17,0409 $7,511 $9,764 $12,017 $14,271 $16,524 $18,777 $18,777

10 $8,206 $10,667 $13,129 $15,591 $18,053 $20,514 $20,514

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Page 15: Intensive Outpatient/Partial Hospitalization Liability Tables...Allegheny Intensive Outpatient/Partial Hospitalization Monthly Income Monthly Income Monthly Income Monthly Income Monthly

Che

ster

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $2,630 $3,419 $4,209 $4,998 $5,787 $6,576 $6,5762 $3,566 $4,636 $5,706 $6,776 $7,846 $8,916 $8,9163 $4,502 $5,853 $7,204 $8,554 $9,905 $11,256 $11,2564 $5,438 $7,070 $8,701 $10,333 $11,964 $13,596 $13,5965 $6,374 $8,287 $10,199 $12,111 $14,024 $15,936 $15,9366 $7,310 $9,503 $11,697 $13,890 $16,083 $18,276 $18,2767 $8,246 $10,720 $13,194 $15,668 $18,142 $20,616 $20,6168 $9,182 $11,937 $14,692 $17,446 $20,201 $22,956 $22,9569 $10,118 $13,154 $16,189 $19,225 $22,260 $25,296 $25,296

10 $11,054 $14,371 $17,687 $21,003 $24,320 $27,636 $27,636

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Page 16: Intensive Outpatient/Partial Hospitalization Liability Tables...Allegheny Intensive Outpatient/Partial Hospitalization Monthly Income Monthly Income Monthly Income Monthly Income Monthly

Cla

rion

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,639 $2,131 $2,622 $3,114 $3,606 $4,097 $4,0972 $2,222 $2,889 $3,555 $4,222 $4,889 $5,555 $5,5553 $2,805 $3,647 $4,488 $5,330 $6,172 $7,013 $7,0134 $3,389 $4,405 $5,422 $6,438 $7,455 $8,471 $8,4715 $3,972 $5,163 $6,355 $7,546 $8,738 $9,929 $9,9296 $4,555 $5,921 $7,288 $8,654 $10,021 $11,387 $11,3877 $5,138 $6,680 $8,221 $9,762 $11,304 $12,845 $12,8458 $5,721 $7,438 $9,154 $10,870 $12,587 $14,303 $14,3039 $6,305 $8,196 $10,087 $11,979 $13,870 $15,761 $15,761

10 $6,888 $8,954 $11,020 $13,087 $15,153 $17,219 $17,219

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Page 17: Intensive Outpatient/Partial Hospitalization Liability Tables...Allegheny Intensive Outpatient/Partial Hospitalization Monthly Income Monthly Income Monthly Income Monthly Income Monthly

Cle

arfie

ld

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,568 $2,039 $2,509 $2,979 $3,450 $3,920 $3,9202 $2,126 $2,764 $3,402 $4,040 $4,677 $5,315 $5,3153 $2,684 $3,489 $4,295 $5,100 $5,905 $6,710 $6,7104 $3,242 $4,215 $5,187 $6,160 $7,133 $8,105 $8,1055 $3,800 $4,940 $6,080 $7,220 $8,360 $9,500 $9,5006 $4,358 $5,666 $6,973 $8,280 $9,588 $10,895 $10,8957 $4,916 $6,391 $7,866 $9,341 $10,815 $12,290 $12,2908 $5,474 $7,116 $8,759 $10,401 $12,043 $13,685 $13,6859 $6,032 $7,842 $9,651 $11,461 $13,271 $15,080 $15,080

10 $6,590 $8,567 $10,544 $12,521 $14,498 $16,475 $16,475

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Page 18: Intensive Outpatient/Partial Hospitalization Liability Tables...Allegheny Intensive Outpatient/Partial Hospitalization Monthly Income Monthly Income Monthly Income Monthly Income Monthly

Clin

ton

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,629 $2,117 $2,606 $3,095 $3,583 $4,072 $4,0722 $2,208 $2,871 $3,533 $4,196 $4,858 $5,521 $5,5213 $2,788 $3,624 $4,461 $5,297 $6,134 $6,970 $6,9704 $3,368 $4,378 $5,388 $6,398 $7,409 $8,419 $8,4195 $3,947 $5,131 $6,315 $7,500 $8,684 $9,868 $9,8686 $4,527 $5,885 $7,243 $8,601 $9,959 $11,317 $11,3177 $5,106 $6,638 $8,170 $9,702 $11,234 $12,766 $12,7668 $5,686 $7,392 $9,098 $10,803 $12,509 $14,215 $14,2159 $6,266 $8,145 $10,025 $11,905 $13,784 $15,664 $15,664

10 $6,845 $8,899 $10,952 $13,006 $15,059 $17,113 $17,113

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Page 19: Intensive Outpatient/Partial Hospitalization Liability Tables...Allegheny Intensive Outpatient/Partial Hospitalization Monthly Income Monthly Income Monthly Income Monthly Income Monthly

Col

umbi

a

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,609 $2,091 $2,574 $3,056 $3,539 $4,021 $4,0212 $2,181 $2,835 $3,490 $4,144 $4,798 $5,452 $5,4523 $2,753 $3,579 $4,405 $5,231 $6,057 $6,883 $6,8834 $3,326 $4,323 $5,321 $6,319 $7,317 $8,314 $8,3145 $3,898 $5,068 $6,237 $7,406 $8,576 $9,745 $9,7456 $4,471 $5,812 $7,153 $8,494 $9,835 $11,176 $11,1767 $5,043 $6,556 $8,069 $9,582 $11,094 $12,607 $12,6078 $5,615 $7,300 $8,985 $10,669 $12,354 $14,038 $14,0389 $6,188 $8,044 $9,900 $11,757 $13,613 $15,469 $15,469

10 $6,760 $8,788 $10,816 $12,844 $14,872 $16,900 $16,900

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Page 20: Intensive Outpatient/Partial Hospitalization Liability Tables...Allegheny Intensive Outpatient/Partial Hospitalization Monthly Income Monthly Income Monthly Income Monthly Income Monthly

Cra

wfo

rd

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,629 $2,117 $2,606 $3,095 $3,583 $4,072 $4,0722 $2,208 $2,871 $3,533 $4,196 $4,858 $5,521 $5,5213 $2,788 $3,624 $4,461 $5,297 $6,134 $6,970 $6,9704 $3,368 $4,378 $5,388 $6,398 $7,409 $8,419 $8,4195 $3,947 $5,131 $6,315 $7,500 $8,684 $9,868 $9,8686 $4,527 $5,885 $7,243 $8,601 $9,959 $11,317 $11,3177 $5,106 $6,638 $8,170 $9,702 $11,234 $12,766 $12,7668 $5,686 $7,392 $9,098 $10,803 $12,509 $14,215 $14,2159 $6,266 $8,145 $10,025 $11,905 $13,784 $15,664 $15,664

10 $6,845 $8,899 $10,952 $13,006 $15,059 $17,113 $17,113

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Page 21: Intensive Outpatient/Partial Hospitalization Liability Tables...Allegheny Intensive Outpatient/Partial Hospitalization Monthly Income Monthly Income Monthly Income Monthly Income Monthly

Cum

berla

nd

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,831 $2,380 $2,930 $3,479 $4,028 $4,578 $4,5782 $2,483 $3,228 $3,972 $4,717 $5,462 $6,207 $6,2073 $3,134 $4,075 $5,015 $5,955 $6,895 $7,836 $7,8364 $3,786 $4,922 $6,057 $7,193 $8,329 $9,465 $9,4655 $4,438 $5,769 $7,100 $8,431 $9,763 $11,094 $11,0946 $5,089 $6,616 $8,143 $9,669 $11,196 $12,723 $12,7237 $5,741 $7,463 $9,185 $10,907 $12,630 $14,352 $14,3528 $6,392 $8,310 $10,228 $12,145 $14,063 $15,981 $15,9819 $7,044 $9,157 $11,270 $13,383 $15,497 $17,610 $17,610

10 $7,696 $10,004 $12,313 $14,621 $16,930 $19,239 $19,239

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Page 22: Intensive Outpatient/Partial Hospitalization Liability Tables...Allegheny Intensive Outpatient/Partial Hospitalization Monthly Income Monthly Income Monthly Income Monthly Income Monthly

Dau

phin

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,831 $2,380 $2,930 $3,479 $4,028 $4,578 $4,5782 $2,483 $3,228 $3,972 $4,717 $5,462 $6,207 $6,2073 $3,134 $4,075 $5,015 $5,955 $6,895 $7,836 $7,8364 $3,786 $4,922 $6,057 $7,193 $8,329 $9,465 $9,4655 $4,438 $5,769 $7,100 $8,431 $9,763 $11,094 $11,0946 $5,089 $6,616 $8,143 $9,669 $11,196 $12,723 $12,7237 $5,741 $7,463 $9,185 $10,907 $12,630 $14,352 $14,3528 $6,392 $8,310 $10,228 $12,145 $14,063 $15,981 $15,9819 $7,044 $9,157 $11,270 $13,383 $15,497 $17,610 $17,610

10 $7,696 $10,004 $12,313 $14,621 $16,930 $19,239 $19,239

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Page 23: Intensive Outpatient/Partial Hospitalization Liability Tables...Allegheny Intensive Outpatient/Partial Hospitalization Monthly Income Monthly Income Monthly Income Monthly Income Monthly

Del

awar

e

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $2,357 $3,064 $3,771 $4,479 $5,186 $5,893 $5,8932 $3,196 $4,155 $5,114 $6,072 $7,031 $7,990 $7,9903 $4,035 $5,245 $6,456 $7,666 $8,877 $10,087 $10,0874 $4,874 $6,336 $7,798 $9,260 $10,722 $12,184 $12,1845 $5,712 $7,426 $9,140 $10,854 $12,567 $14,281 $14,2816 $6,551 $8,517 $10,482 $12,447 $14,413 $16,378 $16,3787 $7,390 $9,607 $11,824 $14,041 $16,258 $18,475 $18,4758 $8,229 $10,697 $13,166 $15,635 $18,103 $20,572 $20,5729 $9,068 $11,788 $14,508 $17,228 $19,949 $22,669 $22,669

10 $9,906 $12,878 $15,850 $18,822 $21,794 $24,766 $24,766

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Page 24: Intensive Outpatient/Partial Hospitalization Liability Tables...Allegheny Intensive Outpatient/Partial Hospitalization Monthly Income Monthly Income Monthly Income Monthly Income Monthly

Elk

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,598 $2,078 $2,557 $3,037 $3,517 $3,996 $3,9962 $2,167 $2,817 $3,468 $4,118 $4,768 $5,418 $5,4183 $2,736 $3,557 $4,378 $5,198 $6,019 $6,840 $6,8404 $3,305 $4,296 $5,288 $6,279 $7,271 $8,262 $8,2625 $3,874 $5,036 $6,198 $7,360 $8,522 $9,684 $9,6846 $4,442 $5,775 $7,108 $8,441 $9,773 $11,106 $11,1067 $5,011 $6,515 $8,018 $9,521 $11,025 $12,528 $12,5288 $5,580 $7,254 $8,928 $10,602 $12,276 $13,950 $13,9509 $6,149 $7,993 $9,838 $11,683 $13,527 $15,372 $15,372

10 $6,718 $8,733 $10,748 $12,764 $14,779 $16,794 $16,794

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Page 25: Intensive Outpatient/Partial Hospitalization Liability Tables...Allegheny Intensive Outpatient/Partial Hospitalization Monthly Income Monthly Income Monthly Income Monthly Income Monthly

Erie

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,619 $2,104 $2,590 $3,075 $3,561 $4,047 $4,0472 $2,195 $2,853 $3,511 $4,170 $4,828 $5,487 $5,4873 $2,771 $3,602 $4,433 $5,264 $6,095 $6,927 $6,9274 $3,347 $4,351 $5,355 $6,359 $7,363 $8,367 $8,3675 $3,923 $5,099 $6,276 $7,453 $8,630 $9,807 $9,8076 $4,499 $5,848 $7,198 $8,547 $9,897 $11,247 $11,2477 $5,075 $6,597 $8,119 $9,642 $11,164 $12,687 $12,6878 $5,651 $7,346 $9,041 $10,736 $12,431 $14,127 $14,1279 $6,227 $8,095 $9,963 $11,831 $13,699 $15,567 $15,567

10 $6,803 $8,843 $10,884 $12,925 $14,966 $17,007 $17,007

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Page 26: Intensive Outpatient/Partial Hospitalization Liability Tables...Allegheny Intensive Outpatient/Partial Hospitalization Monthly Income Monthly Income Monthly Income Monthly Income Monthly

Faye

tte

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,568 $2,039 $2,509 $2,979 $3,450 $3,920 $3,9202 $2,126 $2,764 $3,402 $4,040 $4,677 $5,315 $5,3153 $2,684 $3,489 $4,295 $5,100 $5,905 $6,710 $6,7104 $3,242 $4,215 $5,187 $6,160 $7,133 $8,105 $8,1055 $3,800 $4,940 $6,080 $7,220 $8,360 $9,500 $9,5006 $4,358 $5,666 $6,973 $8,280 $9,588 $10,895 $10,8957 $4,916 $6,391 $7,866 $9,341 $10,815 $12,290 $12,2908 $5,474 $7,116 $8,759 $10,401 $12,043 $13,685 $13,6859 $6,032 $7,842 $9,651 $11,461 $13,271 $15,080 $15,080

10 $6,590 $8,567 $10,544 $12,521 $14,498 $16,475 $16,475

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Page 27: Intensive Outpatient/Partial Hospitalization Liability Tables...Allegheny Intensive Outpatient/Partial Hospitalization Monthly Income Monthly Income Monthly Income Monthly Income Monthly

Fore

st

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,629 $2,117 $2,606 $3,095 $3,583 $4,072 $4,0722 $2,208 $2,871 $3,533 $4,196 $4,858 $5,521 $5,5213 $2,788 $3,624 $4,461 $5,297 $6,134 $6,970 $6,9704 $3,368 $4,378 $5,388 $6,398 $7,409 $8,419 $8,4195 $3,947 $5,131 $6,315 $7,500 $8,684 $9,868 $9,8686 $4,527 $5,885 $7,243 $8,601 $9,959 $11,317 $11,3177 $5,106 $6,638 $8,170 $9,702 $11,234 $12,766 $12,7668 $5,686 $7,392 $9,098 $10,803 $12,509 $14,215 $14,2159 $6,266 $8,145 $10,025 $11,905 $13,784 $15,664 $15,664

10 $6,845 $8,899 $10,952 $13,006 $15,059 $17,113 $17,113

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Page 28: Intensive Outpatient/Partial Hospitalization Liability Tables...Allegheny Intensive Outpatient/Partial Hospitalization Monthly Income Monthly Income Monthly Income Monthly Income Monthly

Fran

klin

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,619 $2,104 $2,590 $3,075 $3,561 $4,047 $4,0472 $2,195 $2,853 $3,511 $4,170 $4,828 $5,487 $5,4873 $2,771 $3,602 $4,433 $5,264 $6,095 $6,927 $6,9274 $3,347 $4,351 $5,355 $6,359 $7,363 $8,367 $8,3675 $3,923 $5,099 $6,276 $7,453 $8,630 $9,807 $9,8076 $4,499 $5,848 $7,198 $8,547 $9,897 $11,247 $11,2477 $5,075 $6,597 $8,119 $9,642 $11,164 $12,687 $12,6878 $5,651 $7,346 $9,041 $10,736 $12,431 $14,127 $14,1279 $6,227 $8,095 $9,963 $11,831 $13,699 $15,567 $15,567

10 $6,803 $8,843 $10,884 $12,925 $14,966 $17,007 $17,007

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Page 29: Intensive Outpatient/Partial Hospitalization Liability Tables...Allegheny Intensive Outpatient/Partial Hospitalization Monthly Income Monthly Income Monthly Income Monthly Income Monthly

Fulto

n

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,578 $2,052 $2,525 $2,999 $3,472 $3,946 $3,9462 $2,140 $2,782 $3,424 $4,066 $4,708 $5,350 $5,3503 $2,701 $3,512 $4,322 $5,133 $5,943 $6,754 $6,7544 $3,263 $4,242 $5,221 $6,200 $7,179 $8,158 $8,1585 $3,825 $4,972 $6,119 $7,267 $8,414 $9,562 $9,5626 $4,386 $5,702 $7,018 $8,334 $9,650 $10,966 $10,9667 $4,948 $6,432 $7,916 $9,401 $10,885 $12,370 $12,3708 $5,509 $7,162 $8,815 $10,468 $12,121 $13,774 $13,7749 $6,071 $7,892 $9,714 $11,535 $13,356 $15,178 $15,178

10 $6,633 $8,622 $10,612 $12,602 $14,592 $16,582 $16,582

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Page 30: Intensive Outpatient/Partial Hospitalization Liability Tables...Allegheny Intensive Outpatient/Partial Hospitalization Monthly Income Monthly Income Monthly Income Monthly Income Monthly

Gre

ene

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,619 $2,104 $2,590 $3,075 $3,561 $4,047 $4,0472 $2,195 $2,853 $3,511 $4,170 $4,828 $5,487 $5,4873 $2,771 $3,602 $4,433 $5,264 $6,095 $6,927 $6,9274 $3,347 $4,351 $5,355 $6,359 $7,363 $8,367 $8,3675 $3,923 $5,099 $6,276 $7,453 $8,630 $9,807 $9,8076 $4,499 $5,848 $7,198 $8,547 $9,897 $11,247 $11,2477 $5,075 $6,597 $8,119 $9,642 $11,164 $12,687 $12,6878 $5,651 $7,346 $9,041 $10,736 $12,431 $14,127 $14,1279 $6,227 $8,095 $9,963 $11,831 $13,699 $15,567 $15,567

10 $6,803 $8,843 $10,884 $12,925 $14,966 $17,007 $17,007

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Page 31: Intensive Outpatient/Partial Hospitalization Liability Tables...Allegheny Intensive Outpatient/Partial Hospitalization Monthly Income Monthly Income Monthly Income Monthly Income Monthly

Hun

tingd

on

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,548 $2,012 $2,477 $2,941 $3,405 $3,870 $3,8702 $2,099 $2,728 $3,358 $3,987 $4,617 $5,247 $5,2473 $2,649 $3,444 $4,239 $5,034 $5,829 $6,624 $6,6244 $3,200 $4,160 $5,120 $6,080 $7,041 $8,001 $8,0015 $3,751 $4,876 $6,002 $7,127 $8,252 $9,378 $9,3786 $4,302 $5,592 $6,883 $8,174 $9,464 $10,755 $10,7557 $4,853 $6,308 $7,764 $9,220 $10,676 $12,132 $12,1328 $5,403 $7,024 $8,646 $10,267 $11,888 $13,509 $13,5099 $5,954 $7,741 $9,527 $11,313 $13,099 $14,886 $14,886

10 $6,505 $8,457 $10,408 $12,360 $14,311 $16,263 $16,263

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Page 32: Intensive Outpatient/Partial Hospitalization Liability Tables...Allegheny Intensive Outpatient/Partial Hospitalization Monthly Income Monthly Income Monthly Income Monthly Income Monthly

Indi

ana

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,639 $2,131 $2,622 $3,114 $3,606 $4,097 $4,0972 $2,222 $2,889 $3,555 $4,222 $4,889 $5,555 $5,5553 $2,805 $3,647 $4,488 $5,330 $6,172 $7,013 $7,0134 $3,389 $4,405 $5,422 $6,438 $7,455 $8,471 $8,4715 $3,972 $5,163 $6,355 $7,546 $8,738 $9,929 $9,9296 $4,555 $5,921 $7,288 $8,654 $10,021 $11,387 $11,3877 $5,138 $6,680 $8,221 $9,762 $11,304 $12,845 $12,8458 $5,721 $7,438 $9,154 $10,870 $12,587 $14,303 $14,3039 $6,305 $8,196 $10,087 $11,979 $13,870 $15,761 $15,761

10 $6,888 $8,954 $11,020 $13,087 $15,153 $17,219 $17,219

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Page 33: Intensive Outpatient/Partial Hospitalization Liability Tables...Allegheny Intensive Outpatient/Partial Hospitalization Monthly Income Monthly Income Monthly Income Monthly Income Monthly

Jeffe

rson

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,568 $2,039 $2,509 $2,979 $3,450 $3,920 $3,9202 $2,126 $2,764 $3,402 $4,040 $4,677 $5,315 $5,3153 $2,684 $3,489 $4,295 $5,100 $5,905 $6,710 $6,7104 $3,242 $4,215 $5,187 $6,160 $7,133 $8,105 $8,1055 $3,800 $4,940 $6,080 $7,220 $8,360 $9,500 $9,5006 $4,358 $5,666 $6,973 $8,280 $9,588 $10,895 $10,8957 $4,916 $6,391 $7,866 $9,341 $10,815 $12,290 $12,2908 $5,474 $7,116 $8,759 $10,401 $12,043 $13,685 $13,6859 $6,032 $7,842 $9,651 $11,461 $13,271 $15,080 $15,080

10 $6,590 $8,567 $10,544 $12,521 $14,498 $16,475 $16,475

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Page 34: Intensive Outpatient/Partial Hospitalization Liability Tables...Allegheny Intensive Outpatient/Partial Hospitalization Monthly Income Monthly Income Monthly Income Monthly Income Monthly

Juni

ata

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,548 $2,012 $2,477 $2,941 $3,405 $3,870 $3,8702 $2,099 $2,728 $3,358 $3,987 $4,617 $5,247 $5,2473 $2,649 $3,444 $4,239 $5,034 $5,829 $6,624 $6,6244 $3,200 $4,160 $5,120 $6,080 $7,041 $8,001 $8,0015 $3,751 $4,876 $6,002 $7,127 $8,252 $9,378 $9,3786 $4,302 $5,592 $6,883 $8,174 $9,464 $10,755 $10,7557 $4,853 $6,308 $7,764 $9,220 $10,676 $12,132 $12,1328 $5,403 $7,024 $8,646 $10,267 $11,888 $13,509 $13,5099 $5,954 $7,741 $9,527 $11,313 $13,099 $14,886 $14,886

10 $6,505 $8,457 $10,408 $12,360 $14,311 $16,263 $16,263

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Page 35: Intensive Outpatient/Partial Hospitalization Liability Tables...Allegheny Intensive Outpatient/Partial Hospitalization Monthly Income Monthly Income Monthly Income Monthly Income Monthly

Lack

awan

na

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,730 $2,249 $2,768 $3,287 $3,806 $4,325 $4,3252 $2,346 $3,049 $3,753 $4,457 $5,160 $5,864 $5,8643 $2,961 $3,849 $4,738 $5,626 $6,515 $7,403 $7,4034 $3,577 $4,650 $5,723 $6,796 $7,869 $8,942 $8,9425 $4,192 $5,450 $6,708 $7,965 $9,223 $10,481 $10,4816 $4,808 $6,250 $7,693 $9,135 $10,577 $12,020 $12,0207 $5,424 $7,051 $8,678 $10,305 $11,932 $13,559 $13,5598 $6,039 $7,851 $9,663 $11,474 $13,286 $15,098 $15,0989 $6,655 $8,651 $10,648 $12,644 $14,640 $16,637 $16,637

10 $7,270 $9,451 $11,633 $13,814 $15,995 $18,176 $18,176

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Page 36: Intensive Outpatient/Partial Hospitalization Liability Tables...Allegheny Intensive Outpatient/Partial Hospitalization Monthly Income Monthly Income Monthly Income Monthly Income Monthly

Lanc

aste

r

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,791 $2,328 $2,865 $3,402 $3,939 $4,477 $4,4772 $2,428 $3,156 $3,885 $4,613 $5,341 $6,070 $6,0703 $3,065 $3,985 $4,904 $5,824 $6,743 $7,663 $7,6634 $3,702 $4,813 $5,924 $7,034 $8,145 $9,256 $9,2565 $4,339 $5,641 $6,943 $8,245 $9,547 $10,849 $10,8496 $4,977 $6,470 $7,963 $9,456 $10,949 $12,442 $12,4427 $5,614 $7,298 $8,982 $10,666 $12,350 $14,035 $14,0358 $6,251 $8,126 $10,002 $11,877 $13,752 $15,628 $15,6289 $6,888 $8,955 $11,021 $13,088 $15,154 $17,221 $17,221

10 $7,525 $9,783 $12,041 $14,298 $16,556 $18,814 $18,814

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Page 37: Intensive Outpatient/Partial Hospitalization Liability Tables...Allegheny Intensive Outpatient/Partial Hospitalization Monthly Income Monthly Income Monthly Income Monthly Income Monthly

Law

renc

e

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,700 $2,209 $2,719 $3,229 $3,739 $4,249 $4,2492 $2,304 $2,996 $3,687 $4,378 $5,070 $5,761 $5,7613 $2,909 $3,782 $4,655 $5,527 $6,400 $7,273 $7,2734 $3,514 $4,568 $5,622 $6,677 $7,731 $8,785 $8,7855 $4,119 $5,354 $6,590 $7,826 $9,061 $10,297 $10,2976 $4,724 $6,141 $7,558 $8,975 $10,392 $11,809 $11,8097 $5,328 $6,927 $8,525 $10,124 $11,722 $13,321 $13,3218 $5,933 $7,713 $9,493 $11,273 $13,053 $14,833 $14,8339 $6,538 $8,499 $10,461 $12,422 $14,384 $16,345 $16,345

10 $7,143 $9,286 $11,428 $13,571 $15,714 $17,857 $17,857

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Page 38: Intensive Outpatient/Partial Hospitalization Liability Tables...Allegheny Intensive Outpatient/Partial Hospitalization Monthly Income Monthly Income Monthly Income Monthly Income Monthly

Leba

non

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,639 $2,131 $2,622 $3,114 $3,606 $4,097 $4,0972 $2,222 $2,889 $3,555 $4,222 $4,889 $5,555 $5,5553 $2,805 $3,647 $4,488 $5,330 $6,172 $7,013 $7,0134 $3,389 $4,405 $5,422 $6,438 $7,455 $8,471 $8,4715 $3,972 $5,163 $6,355 $7,546 $8,738 $9,929 $9,9296 $4,555 $5,921 $7,288 $8,654 $10,021 $11,387 $11,3877 $5,138 $6,680 $8,221 $9,762 $11,304 $12,845 $12,8458 $5,721 $7,438 $9,154 $10,870 $12,587 $14,303 $14,3039 $6,305 $8,196 $10,087 $11,979 $13,870 $15,761 $15,761

10 $6,888 $8,954 $11,020 $13,087 $15,153 $17,219 $17,219

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Page 39: Intensive Outpatient/Partial Hospitalization Liability Tables...Allegheny Intensive Outpatient/Partial Hospitalization Monthly Income Monthly Income Monthly Income Monthly Income Monthly

Lehi

gh

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,942 $2,525 $3,108 $3,691 $4,273 $4,856 $4,8562 $2,634 $3,424 $4,214 $5,004 $5,794 $6,584 $6,5843 $3,325 $4,322 $5,320 $6,317 $7,315 $8,312 $8,3124 $4,016 $5,221 $6,426 $7,630 $8,835 $10,040 $10,0405 $4,707 $6,119 $7,532 $8,944 $10,356 $11,768 $11,7686 $5,398 $7,018 $8,637 $10,257 $11,876 $13,496 $13,4967 $6,090 $7,916 $9,743 $11,570 $13,397 $15,224 $15,2248 $6,781 $8,815 $10,849 $12,884 $14,918 $16,952 $16,9529 $7,472 $9,714 $11,955 $14,197 $16,438 $18,680 $18,680

10 $8,163 $10,612 $13,061 $15,510 $17,959 $20,408 $20,408

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Page 40: Intensive Outpatient/Partial Hospitalization Liability Tables...Allegheny Intensive Outpatient/Partial Hospitalization Monthly Income Monthly Income Monthly Income Monthly Income Monthly

Luze

rne

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,679 $2,183 $2,687 $3,191 $3,695 $4,198 $4,1982 $2,277 $2,960 $3,643 $4,326 $5,009 $5,692 $5,6923 $2,875 $3,737 $4,599 $5,462 $6,324 $7,186 $7,1864 $3,472 $4,514 $5,555 $6,597 $7,639 $8,680 $8,6805 $4,070 $5,291 $6,512 $7,733 $8,953 $10,174 $10,1746 $4,667 $6,068 $7,468 $8,868 $10,268 $11,668 $11,6687 $5,265 $6,844 $8,424 $10,003 $11,583 $13,162 $13,1628 $5,863 $7,621 $9,380 $11,139 $12,898 $14,656 $14,6569 $6,460 $8,398 $10,336 $12,274 $14,212 $16,150 $16,150

10 $7,058 $9,175 $11,292 $13,410 $15,527 $17,644 $17,644

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Page 41: Intensive Outpatient/Partial Hospitalization Liability Tables...Allegheny Intensive Outpatient/Partial Hospitalization Monthly Income Monthly Income Monthly Income Monthly Income Monthly

Lyco

min

g

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,609 $2,091 $2,574 $3,056 $3,539 $4,021 $4,0212 $2,181 $2,835 $3,490 $4,144 $4,798 $5,452 $5,4523 $2,753 $3,579 $4,405 $5,231 $6,057 $6,883 $6,8834 $3,326 $4,323 $5,321 $6,319 $7,317 $8,314 $8,3145 $3,898 $5,068 $6,237 $7,406 $8,576 $9,745 $9,7456 $4,471 $5,812 $7,153 $8,494 $9,835 $11,176 $11,1767 $5,043 $6,556 $8,069 $9,582 $11,094 $12,607 $12,6078 $5,615 $7,300 $8,985 $10,669 $12,354 $14,038 $14,0389 $6,188 $8,044 $9,900 $11,757 $13,613 $15,469 $15,469

10 $6,760 $8,788 $10,816 $12,844 $14,872 $16,900 $16,900

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Page 42: Intensive Outpatient/Partial Hospitalization Liability Tables...Allegheny Intensive Outpatient/Partial Hospitalization Monthly Income Monthly Income Monthly Income Monthly Income Monthly

McK

ean

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,629 $2,117 $2,606 $3,095 $3,583 $4,072 $4,0722 $2,208 $2,871 $3,533 $4,196 $4,858 $5,521 $5,5213 $2,788 $3,624 $4,461 $5,297 $6,134 $6,970 $6,9704 $3,368 $4,378 $5,388 $6,398 $7,409 $8,419 $8,4195 $3,947 $5,131 $6,315 $7,500 $8,684 $9,868 $9,8686 $4,527 $5,885 $7,243 $8,601 $9,959 $11,317 $11,3177 $5,106 $6,638 $8,170 $9,702 $11,234 $12,766 $12,7668 $5,686 $7,392 $9,098 $10,803 $12,509 $14,215 $14,2159 $6,266 $8,145 $10,025 $11,905 $13,784 $15,664 $15,664

10 $6,845 $8,899 $10,952 $13,006 $15,059 $17,113 $17,113

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Page 43: Intensive Outpatient/Partial Hospitalization Liability Tables...Allegheny Intensive Outpatient/Partial Hospitalization Monthly Income Monthly Income Monthly Income Monthly Income Monthly

Mer

cer

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,609 $2,091 $2,574 $3,056 $3,539 $4,021 $4,0212 $2,181 $2,835 $3,490 $4,144 $4,798 $5,452 $5,4523 $2,753 $3,579 $4,405 $5,231 $6,057 $6,883 $6,8834 $3,326 $4,323 $5,321 $6,319 $7,317 $8,314 $8,3145 $3,898 $5,068 $6,237 $7,406 $8,576 $9,745 $9,7456 $4,471 $5,812 $7,153 $8,494 $9,835 $11,176 $11,1767 $5,043 $6,556 $8,069 $9,582 $11,094 $12,607 $12,6078 $5,615 $7,300 $8,985 $10,669 $12,354 $14,038 $14,0389 $6,188 $8,044 $9,900 $11,757 $13,613 $15,469 $15,469

10 $6,760 $8,788 $10,816 $12,844 $14,872 $16,900 $16,900

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Page 44: Intensive Outpatient/Partial Hospitalization Liability Tables...Allegheny Intensive Outpatient/Partial Hospitalization Monthly Income Monthly Income Monthly Income Monthly Income Monthly

Miff

lin

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,538 $1,999 $2,460 $2,922 $3,383 $3,844 $3,8442 $2,085 $2,710 $3,336 $3,961 $4,587 $5,212 $5,2123 $2,632 $3,422 $4,211 $5,001 $5,791 $6,580 $6,5804 $3,179 $4,133 $5,087 $6,041 $6,995 $7,948 $7,9485 $3,727 $4,844 $5,962 $7,080 $8,198 $9,316 $9,3166 $4,274 $5,556 $6,838 $8,120 $9,402 $10,684 $10,6847 $4,821 $6,267 $7,713 $9,160 $10,606 $12,052 $12,0528 $5,368 $6,979 $8,589 $10,199 $11,810 $13,420 $13,4209 $5,915 $7,690 $9,465 $11,239 $13,014 $14,788 $14,788

10 $6,463 $8,401 $10,340 $12,279 $14,218 $16,156 $16,156

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Page 45: Intensive Outpatient/Partial Hospitalization Liability Tables...Allegheny Intensive Outpatient/Partial Hospitalization Monthly Income Monthly Income Monthly Income Monthly Income Monthly

Mon

roe

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $2,003 $2,604 $3,205 $3,806 $4,407 $5,008 $5,0082 $2,716 $3,531 $4,345 $5,160 $5,975 $6,790 $6,7903 $3,429 $4,457 $5,486 $6,515 $7,543 $8,572 $8,5724 $4,142 $5,384 $6,626 $7,869 $9,111 $10,354 $10,3545 $4,854 $6,311 $7,767 $9,223 $10,679 $12,136 $12,1366 $5,567 $7,237 $8,907 $10,577 $12,248 $13,918 $13,9187 $6,280 $8,164 $10,048 $11,932 $13,816 $15,700 $15,7008 $6,993 $9,091 $11,188 $13,286 $15,384 $17,482 $17,4829 $7,706 $10,017 $12,329 $14,640 $16,952 $19,264 $19,264

10 $8,418 $10,944 $13,469 $15,995 $18,520 $21,046 $21,046

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Page 46: Intensive Outpatient/Partial Hospitalization Liability Tables...Allegheny Intensive Outpatient/Partial Hospitalization Monthly Income Monthly Income Monthly Income Monthly Income Monthly

Mon

tgom

ery

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $2,590 $3,367 $4,144 $4,921 $5,698 $6,475 $6,4752 $3,511 $4,565 $5,618 $6,672 $7,725 $8,779 $8,7793 $4,433 $5,763 $7,093 $8,423 $9,753 $11,083 $11,0834 $5,355 $6,961 $8,567 $10,174 $11,780 $13,387 $13,3875 $6,276 $8,159 $10,042 $11,925 $13,808 $15,691 $15,6916 $7,198 $9,357 $11,517 $13,676 $15,835 $17,995 $17,9957 $8,119 $10,555 $12,991 $15,427 $17,863 $20,299 $20,2998 $9,041 $11,753 $14,466 $17,178 $19,890 $22,603 $22,6039 $9,963 $12,951 $15,940 $18,929 $21,918 $24,907 $24,907

10 $10,884 $14,150 $17,415 $20,680 $23,945 $27,211 $27,211

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Page 47: Intensive Outpatient/Partial Hospitalization Liability Tables...Allegheny Intensive Outpatient/Partial Hospitalization Monthly Income Monthly Income Monthly Income Monthly Income Monthly

Mon

tour

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,740 $2,262 $2,784 $3,306 $3,828 $4,350 $4,3502 $2,359 $3,067 $3,775 $4,483 $5,190 $5,898 $5,8983 $2,978 $3,872 $4,766 $5,659 $6,553 $7,446 $7,4464 $3,598 $4,677 $5,756 $6,836 $7,915 $8,994 $8,9945 $4,217 $5,482 $6,747 $8,012 $9,277 $10,542 $10,5426 $4,836 $6,287 $7,738 $9,189 $10,639 $12,090 $12,0907 $5,455 $7,092 $8,728 $10,365 $12,002 $13,638 $13,6388 $6,074 $7,897 $9,719 $11,541 $13,364 $15,186 $15,1869 $6,694 $8,702 $10,710 $12,718 $14,726 $16,734 $16,734

10 $7,313 $9,507 $11,701 $13,894 $16,088 $18,282 $18,282

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Page 48: Intensive Outpatient/Partial Hospitalization Liability Tables...Allegheny Intensive Outpatient/Partial Hospitalization Monthly Income Monthly Income Monthly Income Monthly Income Monthly

Nor

tham

pton

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,983 $2,578 $3,173 $3,767 $4,362 $4,957 $4,9572 $2,688 $3,495 $4,302 $5,108 $5,915 $6,721 $6,7213 $3,394 $4,412 $5,431 $6,449 $7,467 $8,485 $8,4854 $4,100 $5,330 $6,559 $7,789 $9,019 $10,249 $10,2495 $4,805 $6,247 $7,688 $9,130 $10,572 $12,013 $12,0136 $5,511 $7,164 $8,817 $10,471 $12,124 $13,777 $13,7777 $6,216 $8,081 $9,946 $11,811 $13,676 $15,541 $15,5418 $6,922 $8,999 $11,075 $13,152 $15,229 $17,305 $17,3059 $7,628 $9,916 $12,204 $14,493 $16,781 $19,069 $19,069

10 $8,333 $10,833 $13,333 $15,833 $18,333 $20,833 $20,833

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Page 49: Intensive Outpatient/Partial Hospitalization Liability Tables...Allegheny Intensive Outpatient/Partial Hospitalization Monthly Income Monthly Income Monthly Income Monthly Income Monthly

Nor

thum

berla

nd

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,609 $2,091 $2,574 $3,056 $3,539 $4,021 $4,0212 $2,181 $2,835 $3,490 $4,144 $4,798 $5,452 $5,4523 $2,753 $3,579 $4,405 $5,231 $6,057 $6,883 $6,8834 $3,326 $4,323 $5,321 $6,319 $7,317 $8,314 $8,3145 $3,898 $5,068 $6,237 $7,406 $8,576 $9,745 $9,7456 $4,471 $5,812 $7,153 $8,494 $9,835 $11,176 $11,1767 $5,043 $6,556 $8,069 $9,582 $11,094 $12,607 $12,6078 $5,615 $7,300 $8,985 $10,669 $12,354 $14,038 $14,0389 $6,188 $8,044 $9,900 $11,757 $13,613 $15,469 $15,469

10 $6,760 $8,788 $10,816 $12,844 $14,872 $16,900 $16,900

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Page 50: Intensive Outpatient/Partial Hospitalization Liability Tables...Allegheny Intensive Outpatient/Partial Hospitalization Monthly Income Monthly Income Monthly Income Monthly Income Monthly

Perr

y

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,619 $2,104 $2,590 $3,075 $3,561 $4,047 $4,0472 $2,195 $2,853 $3,511 $4,170 $4,828 $5,487 $5,4873 $2,771 $3,602 $4,433 $5,264 $6,095 $6,927 $6,9274 $3,347 $4,351 $5,355 $6,359 $7,363 $8,367 $8,3675 $3,923 $5,099 $6,276 $7,453 $8,630 $9,807 $9,8076 $4,499 $5,848 $7,198 $8,547 $9,897 $11,247 $11,2477 $5,075 $6,597 $8,119 $9,642 $11,164 $12,687 $12,6878 $5,651 $7,346 $9,041 $10,736 $12,431 $14,127 $14,1279 $6,227 $8,095 $9,963 $11,831 $13,699 $15,567 $15,567

10 $6,803 $8,843 $10,884 $12,925 $14,966 $17,007 $17,007

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Page 51: Intensive Outpatient/Partial Hospitalization Liability Tables...Allegheny Intensive Outpatient/Partial Hospitalization Monthly Income Monthly Income Monthly Income Monthly Income Monthly

Phila

delp

hia

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $2,003 $2,604 $3,205 $3,806 $4,407 $5,008 $5,0082 $2,716 $3,531 $4,345 $5,160 $5,975 $6,790 $6,7903 $3,429 $4,457 $5,486 $6,515 $7,543 $8,572 $8,5724 $4,142 $5,384 $6,626 $7,869 $9,111 $10,354 $10,3545 $4,854 $6,311 $7,767 $9,223 $10,679 $12,136 $12,1366 $5,567 $7,237 $8,907 $10,577 $12,248 $13,918 $13,9187 $6,280 $8,164 $10,048 $11,932 $13,816 $15,700 $15,7008 $6,993 $9,091 $11,188 $13,286 $15,384 $17,482 $17,4829 $7,706 $10,017 $12,329 $14,640 $16,952 $19,264 $19,264

10 $8,418 $10,944 $13,469 $15,995 $18,520 $21,046 $21,046

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Page 52: Intensive Outpatient/Partial Hospitalization Liability Tables...Allegheny Intensive Outpatient/Partial Hospitalization Monthly Income Monthly Income Monthly Income Monthly Income Monthly

Pike

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $2,226 $2,893 $3,561 $4,229 $4,896 $5,564 $5,5642 $3,018 $3,923 $4,828 $5,734 $6,639 $7,544 $7,5443 $3,810 $4,953 $6,095 $7,238 $8,381 $9,524 $9,5244 $4,602 $5,982 $7,363 $8,743 $10,124 $11,504 $11,5045 $5,394 $7,012 $8,630 $10,248 $11,866 $13,484 $13,4846 $6,186 $8,041 $9,897 $11,753 $13,608 $15,464 $15,4647 $6,978 $9,071 $11,164 $13,258 $15,351 $17,444 $17,4448 $7,770 $10,101 $12,431 $14,762 $17,093 $19,424 $19,4249 $8,562 $11,130 $13,699 $16,267 $18,836 $21,404 $21,404

10 $9,354 $12,160 $14,966 $17,772 $20,578 $23,384 $23,384

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Page 53: Intensive Outpatient/Partial Hospitalization Liability Tables...Allegheny Intensive Outpatient/Partial Hospitalization Monthly Income Monthly Income Monthly Income Monthly Income Monthly

Potte

r

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,629 $2,117 $2,606 $3,095 $3,583 $4,072 $4,0722 $2,208 $2,871 $3,533 $4,196 $4,858 $5,521 $5,5213 $2,788 $3,624 $4,461 $5,297 $6,134 $6,970 $6,9704 $3,368 $4,378 $5,388 $6,398 $7,409 $8,419 $8,4195 $3,947 $5,131 $6,315 $7,500 $8,684 $9,868 $9,8686 $4,527 $5,885 $7,243 $8,601 $9,959 $11,317 $11,3177 $5,106 $6,638 $8,170 $9,702 $11,234 $12,766 $12,7668 $5,686 $7,392 $9,098 $10,803 $12,509 $14,215 $14,2159 $6,266 $8,145 $10,025 $11,905 $13,784 $15,664 $15,664

10 $6,845 $8,899 $10,952 $13,006 $15,059 $17,113 $17,113

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Page 54: Intensive Outpatient/Partial Hospitalization Liability Tables...Allegheny Intensive Outpatient/Partial Hospitalization Monthly Income Monthly Income Monthly Income Monthly Income Monthly

Schu

ylki

ll

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,598 $2,078 $2,557 $3,037 $3,517 $3,996 $3,9962 $2,167 $2,817 $3,468 $4,118 $4,768 $5,418 $5,4183 $2,736 $3,557 $4,378 $5,198 $6,019 $6,840 $6,8404 $3,305 $4,296 $5,288 $6,279 $7,271 $8,262 $8,2625 $3,874 $5,036 $6,198 $7,360 $8,522 $9,684 $9,6846 $4,442 $5,775 $7,108 $8,441 $9,773 $11,106 $11,1067 $5,011 $6,515 $8,018 $9,521 $11,025 $12,528 $12,5288 $5,580 $7,254 $8,928 $10,602 $12,276 $13,950 $13,9509 $6,149 $7,993 $9,838 $11,683 $13,527 $15,372 $15,372

10 $6,718 $8,733 $10,748 $12,764 $14,779 $16,794 $16,794

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Page 55: Intensive Outpatient/Partial Hospitalization Liability Tables...Allegheny Intensive Outpatient/Partial Hospitalization Monthly Income Monthly Income Monthly Income Monthly Income Monthly

Snyd

er

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,639 $2,131 $2,622 $3,114 $3,606 $4,097 $4,0972 $2,222 $2,889 $3,555 $4,222 $4,889 $5,555 $5,5553 $2,805 $3,647 $4,488 $5,330 $6,172 $7,013 $7,0134 $3,389 $4,405 $5,422 $6,438 $7,455 $8,471 $8,4715 $3,972 $5,163 $6,355 $7,546 $8,738 $9,929 $9,9296 $4,555 $5,921 $7,288 $8,654 $10,021 $11,387 $11,3877 $5,138 $6,680 $8,221 $9,762 $11,304 $12,845 $12,8458 $5,721 $7,438 $9,154 $10,870 $12,587 $14,303 $14,3039 $6,305 $8,196 $10,087 $11,979 $13,870 $15,761 $15,761

10 $6,888 $8,954 $11,020 $13,087 $15,153 $17,219 $17,219

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Page 56: Intensive Outpatient/Partial Hospitalization Liability Tables...Allegheny Intensive Outpatient/Partial Hospitalization Monthly Income Monthly Income Monthly Income Monthly Income Monthly

Som

erse

t

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,558 $2,025 $2,493 $2,960 $3,428 $3,895 $3,8952 $2,112 $2,746 $3,380 $4,013 $4,647 $5,281 $5,2813 $2,667 $3,467 $4,267 $5,067 $5,867 $6,667 $6,6674 $3,221 $4,188 $5,154 $6,120 $7,087 $8,053 $8,0535 $3,776 $4,908 $6,041 $7,174 $8,306 $9,439 $9,4396 $4,330 $5,629 $6,928 $8,227 $9,526 $10,825 $10,8257 $4,884 $6,350 $7,815 $9,280 $10,746 $12,211 $12,2118 $5,439 $7,070 $8,702 $10,334 $11,965 $13,597 $13,5979 $5,993 $7,791 $9,589 $11,387 $13,185 $14,983 $14,983

10 $6,548 $8,512 $10,476 $12,440 $14,405 $16,369 $16,369

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Page 57: Intensive Outpatient/Partial Hospitalization Liability Tables...Allegheny Intensive Outpatient/Partial Hospitalization Monthly Income Monthly Income Monthly Income Monthly Income Monthly

Sulli

van

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,598 $2,078 $2,557 $3,037 $3,517 $3,996 $3,9962 $2,167 $2,817 $3,468 $4,118 $4,768 $5,418 $5,4183 $2,736 $3,557 $4,378 $5,198 $6,019 $6,840 $6,8404 $3,305 $4,296 $5,288 $6,279 $7,271 $8,262 $8,2625 $3,874 $5,036 $6,198 $7,360 $8,522 $9,684 $9,6846 $4,442 $5,775 $7,108 $8,441 $9,773 $11,106 $11,1067 $5,011 $6,515 $8,018 $9,521 $11,025 $12,528 $12,5288 $5,580 $7,254 $8,928 $10,602 $12,276 $13,950 $13,9509 $6,149 $7,993 $9,838 $11,683 $13,527 $15,372 $15,372

10 $6,718 $8,733 $10,748 $12,764 $14,779 $16,794 $16,794

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Page 58: Intensive Outpatient/Partial Hospitalization Liability Tables...Allegheny Intensive Outpatient/Partial Hospitalization Monthly Income Monthly Income Monthly Income Monthly Income Monthly

Susq

ueha

nna

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,619 $2,104 $2,590 $3,075 $3,561 $4,047 $4,0472 $2,195 $2,853 $3,511 $4,170 $4,828 $5,487 $5,4873 $2,771 $3,602 $4,433 $5,264 $6,095 $6,927 $6,9274 $3,347 $4,351 $5,355 $6,359 $7,363 $8,367 $8,3675 $3,923 $5,099 $6,276 $7,453 $8,630 $9,807 $9,8076 $4,499 $5,848 $7,198 $8,547 $9,897 $11,247 $11,2477 $5,075 $6,597 $8,119 $9,642 $11,164 $12,687 $12,6878 $5,651 $7,346 $9,041 $10,736 $12,431 $14,127 $14,1279 $6,227 $8,095 $9,963 $11,831 $13,699 $15,567 $15,567

10 $6,803 $8,843 $10,884 $12,925 $14,966 $17,007 $17,007

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Page 59: Intensive Outpatient/Partial Hospitalization Liability Tables...Allegheny Intensive Outpatient/Partial Hospitalization Monthly Income Monthly Income Monthly Income Monthly Income Monthly

Tiog

a

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,679 $2,183 $2,687 $3,191 $3,695 $4,198 $4,1982 $2,277 $2,960 $3,643 $4,326 $5,009 $5,692 $5,6923 $2,875 $3,737 $4,599 $5,462 $6,324 $7,186 $7,1864 $3,472 $4,514 $5,555 $6,597 $7,639 $8,680 $8,6805 $4,070 $5,291 $6,512 $7,733 $8,953 $10,174 $10,1746 $4,667 $6,068 $7,468 $8,868 $10,268 $11,668 $11,6687 $5,265 $6,844 $8,424 $10,003 $11,583 $13,162 $13,1628 $5,863 $7,621 $9,380 $11,139 $12,898 $14,656 $14,6569 $6,460 $8,398 $10,336 $12,274 $14,212 $16,150 $16,150

10 $7,058 $9,175 $11,292 $13,410 $15,527 $17,644 $17,644

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Page 60: Intensive Outpatient/Partial Hospitalization Liability Tables...Allegheny Intensive Outpatient/Partial Hospitalization Monthly Income Monthly Income Monthly Income Monthly Income Monthly

Uni

on

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,730 $2,249 $2,768 $3,287 $3,806 $4,325 $4,3252 $2,346 $3,049 $3,753 $4,457 $5,160 $5,864 $5,8643 $2,961 $3,849 $4,738 $5,626 $6,515 $7,403 $7,4034 $3,577 $4,650 $5,723 $6,796 $7,869 $8,942 $8,9425 $4,192 $5,450 $6,708 $7,965 $9,223 $10,481 $10,4816 $4,808 $6,250 $7,693 $9,135 $10,577 $12,020 $12,0207 $5,424 $7,051 $8,678 $10,305 $11,932 $13,559 $13,5598 $6,039 $7,851 $9,663 $11,474 $13,286 $15,098 $15,0989 $6,655 $8,651 $10,648 $12,644 $14,640 $16,637 $16,637

10 $7,270 $9,451 $11,633 $13,814 $15,995 $18,176 $18,176

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Page 61: Intensive Outpatient/Partial Hospitalization Liability Tables...Allegheny Intensive Outpatient/Partial Hospitalization Monthly Income Monthly Income Monthly Income Monthly Income Monthly

Vena

ngo

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,588 $2,065 $2,541 $3,018 $3,494 $3,971 $3,9712 $2,154 $2,800 $3,446 $4,092 $4,738 $5,384 $5,3843 $2,719 $3,534 $4,350 $5,166 $5,981 $6,797 $6,7974 $3,284 $4,269 $5,254 $6,239 $7,225 $8,210 $8,2105 $3,849 $5,004 $6,159 $7,313 $8,468 $9,623 $9,6236 $4,414 $5,739 $7,063 $8,387 $9,711 $11,036 $11,0367 $4,980 $6,473 $7,967 $9,461 $10,955 $12,449 $12,4498 $5,545 $7,208 $8,872 $10,535 $12,198 $13,862 $13,8629 $6,110 $7,943 $9,776 $11,609 $13,442 $15,275 $15,275

10 $6,675 $8,678 $10,680 $12,683 $14,685 $16,688 $16,688

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Page 62: Intensive Outpatient/Partial Hospitalization Liability Tables...Allegheny Intensive Outpatient/Partial Hospitalization Monthly Income Monthly Income Monthly Income Monthly Income Monthly

War

ren

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,609 $2,091 $2,574 $3,056 $3,539 $4,021 $4,0212 $2,181 $2,835 $3,490 $4,144 $4,798 $5,452 $5,4523 $2,753 $3,579 $4,405 $5,231 $6,057 $6,883 $6,8834 $3,326 $4,323 $5,321 $6,319 $7,317 $8,314 $8,3145 $3,898 $5,068 $6,237 $7,406 $8,576 $9,745 $9,7456 $4,471 $5,812 $7,153 $8,494 $9,835 $11,176 $11,1767 $5,043 $6,556 $8,069 $9,582 $11,094 $12,607 $12,6078 $5,615 $7,300 $8,985 $10,669 $12,354 $14,038 $14,0389 $6,188 $8,044 $9,900 $11,757 $13,613 $15,469 $15,469

10 $6,760 $8,788 $10,816 $12,844 $14,872 $16,900 $16,900

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Page 63: Intensive Outpatient/Partial Hospitalization Liability Tables...Allegheny Intensive Outpatient/Partial Hospitalization Monthly Income Monthly Income Monthly Income Monthly Income Monthly

Was

hing

ton

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,639 $2,131 $2,622 $3,114 $3,606 $4,097 $4,0972 $2,222 $2,889 $3,555 $4,222 $4,889 $5,555 $5,5553 $2,805 $3,647 $4,488 $5,330 $6,172 $7,013 $7,0134 $3,389 $4,405 $5,422 $6,438 $7,455 $8,471 $8,4715 $3,972 $5,163 $6,355 $7,546 $8,738 $9,929 $9,9296 $4,555 $5,921 $7,288 $8,654 $10,021 $11,387 $11,3877 $5,138 $6,680 $8,221 $9,762 $11,304 $12,845 $12,8458 $5,721 $7,438 $9,154 $10,870 $12,587 $14,303 $14,3039 $6,305 $8,196 $10,087 $11,979 $13,870 $15,761 $15,761

10 $6,888 $8,954 $11,020 $13,087 $15,153 $17,219 $17,219

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Page 64: Intensive Outpatient/Partial Hospitalization Liability Tables...Allegheny Intensive Outpatient/Partial Hospitalization Monthly Income Monthly Income Monthly Income Monthly Income Monthly

Way

ne

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,689 $2,196 $2,703 $3,210 $3,717 $4,224 $4,2242 $2,291 $2,978 $3,665 $4,352 $5,040 $5,727 $5,7273 $2,892 $3,759 $4,627 $5,495 $6,362 $7,230 $7,2304 $3,493 $4,541 $5,589 $6,637 $7,685 $8,733 $8,7335 $4,094 $5,323 $6,551 $7,779 $9,007 $10,236 $10,2366 $4,695 $6,104 $7,513 $8,921 $10,330 $11,739 $11,7397 $5,297 $6,886 $8,475 $10,064 $11,653 $13,242 $13,2428 $5,898 $7,667 $9,437 $11,206 $12,975 $14,745 $14,7459 $6,499 $8,449 $10,399 $12,348 $14,298 $16,248 $16,248

10 $7,100 $9,230 $11,360 $13,491 $15,621 $17,751 $17,751

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Page 65: Intensive Outpatient/Partial Hospitalization Liability Tables...Allegheny Intensive Outpatient/Partial Hospitalization Monthly Income Monthly Income Monthly Income Monthly Income Monthly

Wes

tmor

elan

d

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,669 $2,170 $2,671 $3,172 $3,672 $4,173 $4,1732 $2,263 $2,942 $3,621 $4,300 $4,979 $5,658 $5,6583 $2,857 $3,714 $4,572 $5,429 $6,286 $7,143 $7,1434 $3,451 $4,487 $5,522 $6,557 $7,593 $8,628 $8,6285 $4,045 $5,259 $6,472 $7,686 $8,900 $10,113 $10,1136 $4,639 $6,031 $7,423 $8,815 $10,206 $11,598 $11,5987 $5,233 $6,803 $8,373 $9,943 $11,513 $13,083 $13,0838 $5,827 $7,575 $9,324 $11,072 $12,820 $14,568 $14,5689 $6,421 $8,348 $10,274 $12,200 $14,127 $16,053 $16,053

10 $7,015 $9,120 $11,224 $13,329 $15,434 $17,538 $17,538

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Page 66: Intensive Outpatient/Partial Hospitalization Liability Tables...Allegheny Intensive Outpatient/Partial Hospitalization Monthly Income Monthly Income Monthly Income Monthly Income Monthly

Wyo

min

g

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,679 $2,183 $2,687 $3,191 $3,695 $4,198 $4,1982 $2,277 $2,960 $3,643 $4,326 $5,009 $5,692 $5,6923 $2,875 $3,737 $4,599 $5,462 $6,324 $7,186 $7,1864 $3,472 $4,514 $5,555 $6,597 $7,639 $8,680 $8,6805 $4,070 $5,291 $6,512 $7,733 $8,953 $10,174 $10,1746 $4,667 $6,068 $7,468 $8,868 $10,268 $11,668 $11,6687 $5,265 $6,844 $8,424 $10,003 $11,583 $13,162 $13,1628 $5,863 $7,621 $9,380 $11,139 $12,898 $14,656 $14,6569 $6,460 $8,398 $10,336 $12,274 $14,212 $16,150 $16,150

10 $7,058 $9,175 $11,292 $13,410 $15,527 $17,644 $17,644

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Page 67: Intensive Outpatient/Partial Hospitalization Liability Tables...Allegheny Intensive Outpatient/Partial Hospitalization Monthly Income Monthly Income Monthly Income Monthly Income Monthly

York

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,689 $2,196 $2,703 $3,210 $3,717 $4,224 $4,2242 $2,291 $2,978 $3,665 $4,352 $5,040 $5,727 $5,7273 $2,892 $3,759 $4,627 $5,495 $6,362 $7,230 $7,2304 $3,493 $4,541 $5,589 $6,637 $7,685 $8,733 $8,7335 $4,094 $5,323 $6,551 $7,779 $9,007 $10,236 $10,2366 $4,695 $6,104 $7,513 $8,921 $10,330 $11,739 $11,7397 $5,297 $6,886 $8,475 $10,064 $11,653 $13,242 $13,2428 $5,898 $7,667 $9,437 $11,206 $12,975 $14,745 $14,7459 $6,499 $8,449 $10,399 $12,348 $14,298 $16,248 $16,248

10 $7,100 $9,230 $11,360 $13,491 $15,621 $17,751 $17,751

Client Liability: 0% 10% 20% 30% 40% 50% 100%